MEDICARE: IDELLE TAYE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP126033	TX
2	363LP2300X	Primary Care Nurse Practitioner	AP126033	TX
3	363L00000X	Nurse Practitioner	AP126033	TX

General Provider Information

NPI Number	:	1770991648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDELLE TAYE NP

Provider Business Mailing Address
First Line	:	871 LAKE CAROLYN PKWY APT 211
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-4590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13737 NOEL RD STE 1600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1374
Country	:	US
Telephone Number	:	800-362-2731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	02/18/2026

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